South African Journal of Physiotherapy最新文献

Background: It is generally accepted that braces can stop curve progression but little evidence exists regarding structural improvement in the spine using spinal bracing. Our study aimed to investigate the possible structural improvements of vertebral wedging with high correction bracing.

Objectives: The aim of our study was to assess whether spinal brace treatment may influence vertebral wedging in adolescent idiopathic scoliosis (AIS).

Method: We reviewed our database according to the following inclusion criteria: girls with a diagnosis of AIS, Risser 0-2, age 10-14 years with Cobb angles greater than 35°. Our study cohort consisted of 27 patients fulfilling the inclusion criteria with an average brace wearing time of 16.6 h per day and Cobb angles between 36° and 79°. The target value for our study was the apical vertebra wedging, measured twice before brace treatment commenced and twice after the average follow-up period of 20.5 months of treatment.

Results: The average apex wedging noted before brace wearing started was 9.8° (median: 9) and after a period of 20.5 months of brace wearing, it had reduced to an average of 5.8° (median: 4.9), (p < 0.001). This would indicate a structural correction of 44%.

Conclusions: Our study supports the hypothesis that spinal high correction braces improve the degree of vertebral wedging in skeletally immature girls with AIS.

Clinical implications: Structural corrections of the apical vertebra seem possible when high correction asymmetric braces are used in the treatment of patients with AIS.

Background: Spinal deformity is the oldest disease known to humankind. Many types of treatment methods, including both conservative and surgical, are in use.

Objective: We aimed to validate a published guideline protocol based on the conservative treatment of spinal deformities.

Method: A modified Delphi technique was used with a questionnaire sent out to professionals worldwide regarding the conservative treatment of spinal deformities.

Results: Our study was completed after two rounds. A strong level of agreement of 80% and more (consensus cut-off point) was achieved in most questions in the first round. Some statements were below this margin, and they were sent to the participants via email in the second round for re-evaluation. Consensus was achieved in almost all of the statements in the second round. Only two items did not reach the cut-off point but were close to this value.

Conclusion: This proposed Guideline Protocol was approved by the participants using the Delphi method and can be used as a valid tool for the conservative treatment of spinal deformities.

Clinical implications: A conservative treatment guideline in spinal deformity management, will provide consistency in treatment and will facilitate comparability with surgery. It will be useful in determining the cost-effectiveness of treatment and in choosing the right patient for the right method of treatment. This guideline might help in this context, and may also create a systematic method for clinicians to use as a reference in both research and clinical practice.

Introduction: This is a case report of a juvenile female patient with scoliosis following two heart surgeries for congenital heart disease (CHD).

Patient presentation management and outcome: Initially, the premenarchial female was 9 years old and had a Tanner stage 2-3 with a single thoracic curve of 65° Cobb. Because of the high risk for progression, immediate brace treatment was proposed as the father declined surgery. The patient received intensive treatment according to the Schroth Best Practice® programme and a Gensingen Brace® designed for large thoracic curves. Over the 18 months following the initial visit, she received two additional braces. As a result, the progression of the main curve was prevented. The patient continues to maintain an improved cosmetic result and is currently at a Risser 2.

Conclusion: Surgery performed for CHD in rare cases may lead to stiff spinal deformity as a consequence of that surgery. Progression of a severe and stiff curve was prevented during the most vulnerable phase of the pubertal growth spurt with an improved clinical result. Therefore, we assume that the patient may have a normal life in adulthood with minor restrictions only. Supported by pattern-specific high correction exercises and braces, these typical single thoracic curves can be re-compensated to a more balanced appearance, less prone to progression in adulthood.

Clinical implications: Because of the relative high risks of spinal fusion and the long-term unknowns of such an intervention, high-impact conservative treatment should be implemented first before surgical correction is considered.

[This corrects the article DOI: 10.4102/sajp.v76i1.1430.].

Background: Investigation into, and description of competencies in the various sectors in which the physiotherapy profession is practised, contribute to the standardisation of practice, professional education, and guides research and administration, and is necessary in South Africa.

Objective: To identify the competencies implemented by physiotherapists working in an educational setting for learners with special needs and to determine physiotherapists' opinions on the identified competencies.

Methods: A sequential mixed method research design was implemented to explore the competencies that physiotherapists implement during their intervention for children with special needs through focus group discussions (FGDs). A questionnaire based on the statements that emerged from the thematic analysis of the transcribed FGDs, and validated, was implemented in a cross-sectional survey amongst all physiotherapists employed in special schools. SPSS version 24 was used for the analysis of closed responses and thematic analysis was done on open-ended responses (n = 22).

Results: The respondents' knowledge and skills regarding physiotherapy theories and implementation ranged from 'good' to 'very good'. However, integration of the therapeutic knowledge and skills in different aspects of the special educational environment, and community integration, were rated 'poor' to 'fair'. Support of physiotherapists to implement policies and procedures, and to attend continuing professional development, ranged from 'fair' to 'poor'.

Conclusion: Lack of knowledge in educational policies and procedures in classroom strategies negatively influence the integration of therapeutic strategies in the special educational environment.

Clinical implications: The contribution of our study to learners with special needs in schools was outlined.

[This corrects the article DOI: 10.4102/sajp.v77i1.1527.].

[This corrects the article DOI: 10.4102/sajp.v76i1.1475.].

Background: In pattern-specific scoliosis exercises and bracing, the corrective treatment plan differs according to different curve patterns. There are a limited number of studies investigating the reliability of the commonly used classifications systems.

Objective: To test the reliability of the augmented Lehnert-Schroth (ALS) classification and the Rigo classification.

Methods: X-rays and posterior photographs of 45 patients with scoliosis were sent by the first author to three clinicians twice at 1-week intervals. The clinicians classified images according to the ALS and Rigo classifications, and the data were analysed using SPSS V-16. Intraclass correlation coefficients (ICCs) and standard error measurement (SEM) were calculated to evaluate the inter- and intra-observer reliability.

Results: The inter-observer ICC values were 0.552 (ALS), 0.452 (Rigo) for X-ray images and 0.494 (ALS), 0.518 (Rigo) for the photographs. The average intra-observer ICC value was 0.720 (ALS), 0.581 (Rigo) for the X-ray images and 0.726 (ALS) and 0.467 (Rigo) for the photographs.

Conclusions: The results of our study indicate moderate inter-observer reliability for X-ray images using the ALS classification and clinical photographs using the Rigo classification. Intra-observer reliability was moderate to good for X-ray images and clinical photographs using the ALS classification and poor to moderate for X-ray and clinical photographs using the Rigo classification.

Clinical implications: Pattern classifications assist in creating a plan and indication of correction in specific scoliosis physiotherapy and pattern-specific brace applications and surgical treatment. More sub-types are needed to address the individual patterns of curvature. The optimisation of curve classification will likely reduce failures in diagnosis and treatment.